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Turner D Wibbelsman, Daniel B Calem, Anthony Obeid, Phoebe L Mellen, Michelle A. Konkoly, Michael R. Velez, Kareem Sioufi, Durga S Borkar, Ravi Pandit, Michael A. Klufas, Jason Hsu, Carl Regillo, Allen C Ho, Omesh P Gupta, Marc J. Spirn; Clinical outcomes after switch from aflibercept to ranibizumab for macular edema secondary to retinal vein occlusion. Invest. Ophthalmol. Vis. Sci. 2019;60(9):4057. doi: https://doi.org/.
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© ARVO (1962-2015); The Authors (2016-present)
Numerous studies have assessed therapeutic switches in the treatment of retinal vein occlusions (RVO); however, none have evaluated the treatment conversion from aflibercept to ranibizumab. This study analyzes the anatomic and functional outcomes after a switch from aflibercept to ranibizumab therapy for RVO-related macular edema.
Eyes that received at least 3 consecutive intravitreal aflibercept injections for RVO and then switched to ranibizumab therapy were included. Exclusion criteria included a history of diabetic macular edema, neovascular age-related macular degeneration, uveitis, and a history of vitrectomy, laser photocoagulation, or intravitreal ranibizumab therapy 6 months prior to the switch date. At the three visits before (B3, B2, B1) and after the switch (P1, P2, P3) and the switch date itself, best corrected visual acuity (VA), central foveal thickness (CFT) on spectral domain OCT, and presence of intraretinal and subretinal fluid were assessed. Statistical outcomes were compared using generalized estimating equations.
A total of 82 eyes from 81 patients were included. Eyes received a mean of 14.9 (±7.80) intravitreal injections of aflibercept prior to the switching to ranibizumab. There were no significant differences when comparing logMAR VA and CFT from three visits prior to the switch and the switch visit itself. After the therapeutic conversion, VA worsened significantly from the switch visit [logMAR 0.56 (±0.57)] to the P1 [logMAR 0.62 (±0.55)], P2 [logMAR 0.65 (±0.63)], and P3 [logMAR 0.58 (±0.54)] visits (p=0.04, p=0.02, p=0.03, respectively). CFT increased significantly from the switch visit [244 (±138) µm] to the P1 [308 (±186)] and P2 [287 (±175)] visits, but not to the P3 [255 (±118)] visit (p<0.001, p=0.005, p=0.12, respectively).
Short-term functional and anatomical worsening were observed after switching from aflibercept to ranibizumab for the treatment of RVO mitigated by shortening the ranibizumab treatment interval. With additional ranibizumab treatment administered at a shorter interval between injections, central foveal thickness and VA approached levels similar to those at the switch visit. Longer-term, prospective, controlled studies will be needed to better characterize efficacy and durability differences between aflibercept to ranibizumab in this condition.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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